Individual
MRS. CRYSTAL ROSE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
3124 N SHILOH ROAD, CORINTH, MS 38834
(662) 486-2710
(662) 762-0690
Mailing address
3124 N SHILOH ROAD, CORINTH, MS 38834
(662) 486-2710
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
15463
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05529352
—
MS
Enumeration date
01/10/2011
Last updated
11/19/2020
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